现代实用流行病学方法 第二讲 病例对照研究

现代实用流行病学方法第二讲病例对照研究章扬熙通过探索性研究，建立假说；假说是否正确，需进行分析性流行病学研究与实验性流行病学研究来加以验证。病例对照研究（Ｃａｓｅ－ＣｏｎｔｒｏｌＳｔｕｄｙ）是常用的分析性流行病学方法。这种研究通常是通过对一组患有某种...     

精神分裂症及情感性障碍与血清微量元素变化的相关性研究

目的：探索精神分裂症及情感性障碍病人血清微量元素变化。方法：采用原子吸收分光光度计测定精神分裂症（105例）及情感性障碍（29例）血清微量元素含量，并与同地区健康志愿居民（100例）进行对照研究。结果：精神分裂症及情感性障碍病人治疗前血清钙、铜、铁均显增高（P＜0．001），血清镁、锌均显降低（P＜0．001）；精神分裂症病人治疗四周末及六周末血清镁、锌显高于治疗前（P＜0．01），治疗六周末，血清钙、铜、铁显低于治疗前（P＜0．01）；各组血清微量元素的变化均无性别差异（P＜0．05）。结论：血清中某些微量元素含量在精神分裂症及情感性障碍发病期与健康之间存在一定差异。提示精神分裂症及情感性障碍的发病与血清微量元素的改变有关联。     

情感性障碍首次发病与季节与气候的关系临床分析

对402例首次发病的情感性障碍的发病季节及其相应的季平均气温、相对湿度、大气压和日照时数等因素进行比较，发现躁狂首次发作高峰在春季，其发病人数与相应季平均相对湿度、日照时数比较均有统计学意义，而与季平均气温、大气压比较均无统计学意义；抑郁首次发作高峰在冬季，其发病人数与相应季平均日照时数、气温比较有统计学意义，而与季平均相对湿度、大气压比较均无统计学意义。另外发现躁狂和抑郁首次发作与季节之间在性别和遗传史上均无显著性差异。     

《基础流行病学》讲座

1 引言 病因是所有医学工作者共同关心的问题。流行病学研究的主要任务是揭示病因。例如:通过描述流行病学研究对疾病的分布进行观察,然后再将发病水平不同的地区、人群加以比较,分析不同的暴露与疾病的联系,提出病因假说,最终判断暴露与疾病的联系是否是因果关系。这里的因果关系有别     

多种危险因素疾病中各因素发病贡献值的测量方法研究

目的为了评价某一危险因素对个体发病所起的作用，并在多因素暴露情况下比较各个因素对发病的影响大小。方法运用贝叶斯公式，依据相关流行病学理论，建立由相对危险度数值等来测算单个危险因素对个体发病贡献权重的方法。结果建立的方法可以用来比较各个危险因素在个体发病中的贡献大小。结论该测算方法简单方便，结合人群研究及Meta分析结果，能够为疾病的病因学研究和临床决策提供一定依据。     

先兆子痫与大于胎令儿的关联

先兆子痫仍然是孕产妇和围生儿发病与死亡的一个重要原因。虽然过去 5 0年中已经进行了大量相关的基础、临床以及流行病学研究 ,但对其病因和发病机制仍不十分清楚。对先兆子痫的发病机制比较公认的一个假说是胎盘血流灌注减少 ,从而导致胎儿宫内生长发育迟缓和低出生体重。虽然有许多的研究支持该假说 ,但是否这是先兆子痫的唯一发病机制尚存在争议。而且 ,实验研究认为先兆子痫孕妇的心输出量增加 ,血流量也增大 ,相应地子宫胎盘的血流灌注也增加。流行病学研究也没有发现先兆子痫与胎儿生长发育不良有决定性关系。虽然先兆子痫孕妇的胎儿…     

胎儿生长迟缓与成人糖尿病的关系

胎儿生长迟缓是围产儿发病和死亡的主要原因之一。近 10年的流行病学研究还发现其与成人期的胰岛素抵抗综合征 (肥胖、冠心病、高血压、糖耐量异常、2型糖尿病等 )的发生有关。该文综述了胎儿生长迟缓与成人期糖耐量异常、2型糖尿病的流行病学证据及假说     

情感性障碍病人复发相关因素及护理

情感性障碍是一组以情感显著而持久的过度高涨或低落为基础特征的精神障碍.有反复发作的倾向,复发率的高低受多种因素影响,本文对我院160例情感障碍病人的复发因素进行分析,并提出了相应的护理措施,以期能降低病人的复发率.     

抽动性障碍药物治疗分析

用氟哌啶醇、泰必利治疗抽动性障碍46例，结果发病年龄早、病程长、抽动种类多及慢性运动或发声抽动障碍药物疗效较差，疗效与性别、各种病理因素无明显关系。     

胎儿生长迟缓与成人糖尿病的关系

胎儿生长迟缓是围产儿发病和死亡的主要原因之一。近10年的流行病学研究还发现其与成人期的胰岛素抵抗综合征(肥胖、冠心病、高血压、糖耐量异常、2型糖尿病等)的发生有关。该文综述了胎儿生长迟缓与成人期糖耐量异常、2型糖尿病的流行病学证据及假说。     

The epidemiology of schizophrenia and other common mental health disorders in the English-speaking Caribbean.

OBJECTIVE: To report on the epidemiology of schizophrenia and other common mental health disorders in the English-speaking Caribbean. METHODS: The MEDLINE, MEDCARIB and West Indiana electronic databases were searched with the phrases Caribbean AND psychiatry OR mental OR suicide, and items with specific reference to epidemiology were culled and reviewed. RESULTS: The age-corrected incidence rate for schizophrenia per 10,000 is 2.09 in Jamaica, 2.2 per 1000 in Trinidad, and 2.92 in Barbados. These rates are lower than the incidence rates reported for white British people, and significantly lower that the 6- to 18-fold higher risk ratio incidence reported for African Caribbeans living in Britain. A comparative diagnostic study carried out in the United Kingdom (UK) suggests that misdiagnosis plays a significant role in this difference. Relatively low incidence figures for affective disorders, anxiety states, suicide and attempted suicide have been reported for Jamaica, Trinidad, and Barbados. DISCUSSION: Most published epidemiological studies of Caribbean populations center on schizophrenia, because of the startling findings of a large increase in risk ratios for African Caribbean people living in England compared to the white native British people. The etiological evidence is shifting toward factors of racism and social alienation experienced by black people in the UK, and to misdiagnosis by white British psychiatrists. Studies of the role of colonial enslavement and social engineering raise the etiological possibility of a role for social and structural community organization in the genesis of schizophrenia. The Caribbean thus represents a rich crucible for research in the epidemiology and etiology of mental health disorders.     

471名城区小学生行为问题和情绪障碍研究

目的 为了探讨小学生行为问题和情绪障碍形成的危险因素。方法 采用分层随机对照与多因素分析相结合的方法，测量工具为Achenbach儿童行为量表（CBCL）中国标准化版、自编的行为情绪影响因素调查表对徐州市城区四所小学进行分层整群随机抽样。结果 发现行为问题和情绪障碍小学生58人，检出率为12．31％，男女之间差异无显著意义。集中出现的儿童行为问题有多动、分裂样、攻击性行为、社会退缩。骄惯、任性、缺少锻炼现象较普遍。结论 儿童行为问题和情绪障碍为多种因素作用的结果。影响小学生行为和情绪障碍的主要因素可能为：孩子与父母间不良的依恋关系、家庭经济状况差、父母对子女的期望值过高、家庭养育方法不当等．减少和预防儿童行为问题和情绪障碍的发生必须重视提高父母素质和改善家庭精神环境的作用。     

Mental disorders and ecological structure in Nottingham

This paper presents the findings of a specifically geographical investigation of the incidence, distribution and social/environmental correlates of mental disorder in Nottingham. Three diagnostic groups were examined, namely schizophrenia and paranoia, the effective psychoses (or manic depression) and the non-psychotic mental disorders. Analysis of two distinct cohorts of first contact patients for both the schizophrenia and affective psychoses diagnoses yielded markedly dissimilar incidence rates. It is therefore suggested that observed variations in the incidence of specific mental disorders between cities probably reflect such nosocomial (i.e. service related) factors as diagnostic accuracy and the levels of local psychiatric services. It is therefore dangerous to ascribe the variations solely to the contrasting social/environmental milieux found in these cities. The spatial distributions of the selected mental disorders within Nottingham were analysed in the context of a set of 12 distinct ecological areas. These areas were derived from a matrix comprising 105 sub-areas and 40 variables via principal components analysis and a non-hierarchical clustering algorithm. Marked spatial variation in the incidence of all the mental disorders was demonstrated via both traditional mapping and probability mapping techniques. Pearson product-moment analysis revealed that the distributions of the two diagnostically distinct schizophrenia and affective psychoses cohorts were virtually identical. The relationships between the inception rates for the mental disorders and social/environmental attributes were analysed. Stepwise multiple regression models for both the principal components and the individual census variables revealed strong and systematic relationships with all the mental disorders. Although such ecological analysis has limited explanatory power it nevertheless provides useful insights into mental disorder-environmental relationships. It is argued that these can be subsequently best examined at a disaggregated (i.e. behavioural) level.     

The checkered history of American psychiatric epidemiology

Context: American psychiatry has been fascinated with statistics ever since the specialty was created in the early nineteenth century. Initially, psychiatrists hoped that statistics would reveal the benefits of institutional care. Nevertheless, their fascination with statistics was far removed from the growing importance of epidemiology generally. The impetus to create an epidemiology of mental disorders came from the emerging social sciences, whose members were concerned with developing a scientific understanding of individual and social behavior and applying it to a series of pressing social problems. Beginning in the 1920s, the interest of psychiatric epidemiologists shifted to the ways that social environments contributed to the development of mental disorders. This emphasis dramatically changed after 1980 when the policy focus of psychiatric epidemiology became the early identification and prevention of mental illness in individuals. Methods: This article reviews the major developments in psychiatric epidemiology over the past century and a half. Findings: The lack of an adequate classification system for mental illness has precluded the field of psychiatric epidemiology from providing causal understandings that could contribute to more adequate policies to remediate psychiatric disorders. Because of this gap, the policy influence of psychiatric epidemiology has stemmed more from institutional and ideological concerns than from knowledge about the causes of mental disorders. Conclusion: Most of the problems that have bedeviled psychiatric epidemiology since its inception remain unresolved. In particular, until epidemiologists develop adequate methods to measure mental illnesses in community populations, the policy contributions of this field will not be fully realized.     

Lithium therapy

Affective (mood) disorders are common in all ages often chronic or recurrent, destructive of personal and social functioning with significant morbidity and mortality. Diagnosis still rests on the clinical skills of interview, observation and a knowledge of the disorders. Lithium is simple, cheap and effective although underused. It is the main pharmacological agent currently used in bipolar disorders and as an adjunct in other affective disorders. While it does have a narrow therapeutic window and can cause serious morbidity itself, it is safe when delivered properly reducing both morbidity and mortality. Lithium therapy should only be started in a specialist psychiatric setting but other clinicians will be involved either in maintenance treatment or in treating patients for separate disorders who happen also to be on lithium.     

The relationship between social class and mental disorder

The inverse relationship between social class and rates of mental disorders was first documented in early mental hygiene studies at the beginning of this century and similar findings have been demonstrated in numerous contemporary studies. Interpretations of this persistent relationship include a downward drift explanation that posits that a decline in social status occurs as a result of precipitating mental illness, and a social causation model that emphasizes the importance of psychosocial stressors in the onset of mental disorders. A wealth of evidence supporting the social causation model is reviewed, drawing on mental health epidemiology, women's mental health, unemployment and physical health research. Political and economic origins of the downward drift hypothesis are also discussed.     

Genetic influences on smoking behavior and nicotine dependence: a review

Molecular epidemiologic studies suggest genetic factors in the etiology of smoking behavior. Dopamine receptor genes, transporter genes (serotonin and dopamine), and other genes related to metabolism of nicotine are plausible functional candidate genes. Research examining the role of allelic variation in those genes is being actively pursued with respect to nicotine dependence as well as personality characteristics and mental disorders. Some of these genes were reported to be connected with schizophrenia. Although nicotine dependence itself is one of the mental disorders according to the fourth edition of Diagnostic and Statistical Manual of Mental Disorders and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems-10 nomenclature, the high comorbidity between nicotine dependence and other mental disorders such as schizophrenia or affective disorders has been noted. Therefore, the relationship between those mental disorders and tobacco addiction should be cleared up considering the interactive effect of genetic and environmental factors.     

情感性精神障碍患者红细胞5种元素含量测定及临床意义的研究

通过对２５例情感性精神障碍患者和５２名正常对照组的红细胞Ｚｎ、Ｃｕ、Ｆｅ、Ｃａ、Ｍｇ元素含量的研究，发现情感性精神障碍患者Ｚｎ和Ｍｇ元素含量和Ｚｎ／Ｃｕ比值明显低于对照组，而Ｃｕ、Ｆｅ和Ｃａ元素含量明显高于对照组。提示体内Ｚｎ和Ｍｇ元素含量降低，而与Ｃｕ、Ｆｅ和Ｃａ元素含量升高，可能是情感性精神障碍发生和发展的因素之一     

Affective disorders: analysis of their comorbidity in the more frequent psychiatric disorders

Comorbidity is defined as the presence of two or more independent diseases in the same subject. This paper reviews the comorbidity of affective disorders with other mental disorders. We focus on the disorders of anxiety, schizophrenia, dependence on psychoactive substances, eating disorders, personality disorders and obsessive-compulsive disorder. To this end, we have carried out an extensive review that has taken account of numerous studies, as well as of different diagnostic orientations (categorical or dimensional). In general the presence of affective symptoms and/or disorders in the context of other mental pathologies is high. Moreover, comorbidity has a high transcendence with respect to clinical prognosis (worse response to treatments, greater symptomatic persistence, greater tendency to chronicity and greater risk of mortality) and the social consequences (decline in work performance and greater use of resources). Nonetheless, we must bear in mind that the analysis of the comorbidity of affective disorders in other mental disorders is complex and controversial, not only because of its high frequency, but also because of the existence of symptomatic overlap, scarcity of signs and pathognomonic symptoms, variability of diagnostic criteria, applied methodological differences, as well as a scarcity of longitudinal and prospective studies.